Double eyelid surgery

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Asian eyelids are unique in their anatomy, and therefore unique in their appearance. Asian blepharoplasty, often called “Double Eyelid Surgery,” must take into account these differences or the procedure will not produce good results. An inexperienced surgeon might perform Asian blepharoplasty the same way as a traditional blepharoplasty, which can be disastrous. Dr. Dewan has extensive experience with Asian eyelids and offers a customized approach to your surgery.

How is an Asian eyelid different than a non-Asian eyelid?

There are several characteristics unique to an Asian eyelid. These include the eyelid crease, the amount and location of fat in the lid, and the presence of epicanthus.

The eyelid crease: this is perhaps the single most important feature to discuss with patients desiring Asian blepharoplasty. Asian eyelids can have a well-defined eyelid crease that goes all the way across the eyelid, though it is often lower in position than on a non-Asian lid. For other patients, their eyelids may not have a crease at all! Still others may have a partial eyelid crease. And others still may have a crease in 1 eyelid, but not the other! In order to achieve the best results, during your consultation, Dr. Dewan will discuss the type of eyelid crease you have, as well as what you would like to have after the surgery.
Eyelid fat: Asian eyelids typically have more fat that sits lower within the eyelid than non-Asian eyelids. In order to retain the “Asian” appearance of the lid, typically much less fat is removed or sculpted away from the lid than in non-Asian eyelids. Too much fat removal can “westernize” the lid, taking away one of the defining eyelid features of an Asian lid.
Epicanthus: Many Asian patients have the unique feature of epicanthus, where the eyelid skin covers the inside corner of the eye. Asian patients may choose to have the epicanthus eliminated, or they may choose to retain the epicanthus when having Asian blepharoplasty. This can be a much more subtle change to your appearance.

What is the surgery like?

Most patients have surgery in our office. This method is performed using a local anesthetic with no sedation given. This makes for a quick recovery, and limits any sedation-related risk. Some patients may choose to do surgery in an operating facility under mild sedation. This sedative will relax you during your surgery and local anesthetic will also be used to numb your eyelids.

Prior to beginning surgery, Dr. Dewan will confirm the surgical plan with you. Once the surgery begins, Dr. Dewan will carefully place marks on your eyelids for surgery and then numb them using a local anesthetic. You may be asked to open and close your eyes a few times to ensure evenness during surgery, and then sutures will be placed to close the incision. Dr. Dewan will place a bandage over the incisions and you will have a post-operative visit 1 week after surgery.

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Can multiple procedures be performed at once?

Absolutely! Many patients choose to address various concerns in the course of 1 surgery. Some of these additional procedures may include the following:

Epicanthoplasty: this is the removal of the epicanthus as mentioned above.
Lower eyelid blepharoplasty: many patients wish to have full eyelid rejuvenation with a quad blepharoplasty. This will address both the upper lids and the lower eyelid bags.
Ptosis repair: if the eyelid is covering the pupil, patients may choose to have the lid lifted by addressing a slipped muscle.
Brow elevation: brows are often lower as we age, making the eyelid appear even lower. Brow droop can also make us look angry or tired. Lifting the brows is a great way to improve this appearance.
Eyelid lesion removal: small eyelid skin growths are exceptionally common and can be removed during eyelid surgery.

Is there scarring seen in the eyelid after surgery?

Dr. Dewan typically performs double eyelid surgery through an eyelid crease incision. This incision hides exceptionally well in the natural fold of skin in the upper eyelid. Because this skin is very thin, it does not scar with a thicker elevated scar. Even patients with a history of keloid formation tend not to have visible scarring with eyelid surgery.

What is the recovery for Double Eyelid Surgery?

Recovery from Asian blepharoplasty is typically uneventful. Most patients have mild headache-like pain for 1-2 days following surgery. Over-the-counter pain medicine such as Tylenol or ibuprofen can reduce this pain. Any stitches that Dr. Dewan uses will dissolve on their own over 10 days. Most patients have bruising and swelling for this same period of time, and we instruct patients to use lots of ice packs for the first few days after surgery. Patients are able to do roughly 80% of their usual activities with 1-2 days following surgery, including driving. Exercise and heavy lifting should be avoided for 1 week. Your post-operative visit will be 1 week after surgery at which time Dr. Dewan will lift any restrictions.

Before and After Double Eyelid Surgery

Our before and after photos are from right before the surgery to about 5-10 days after. All our photos are unretouched. You can expect additional improvements for several weeks after surgery, and most patients are so happy with their surgeries that they don’t come in after the immediate post-operative visit (though we always are happy to see them).

This patient is 50 years old and had had an Asian blepharoplasty many years ago, before she saw Dr. Dewan. She mentioned that she “hated” her eyes, that she had lost her confidence and worst of all, that she did not look like herself after her previous surgery. She did not think her eyes were symmetrical and thought her lids appeared “unusual.” Her goal was to look “more normal” and “more like herself.” To help her achieve her goals, Dr. Dewan performed a revision Asian blepharoplasty, and also defined her crease on both sides. This photo is from 12 days after her surgery. Despite having a lot of healing left, she was thrilled with the outcome and felt she could be confident again!

before and after 13 — This patient is 33 years old and wanted her eyes to look more even. Her right eyelid had no crease and it made that eye look fuller and her face look asymmetric. She said her right eye appeared closed in all her pictures. She had an upper eyelid blepharoplasty and crease formation in our office. The after photo is 7 days after the surgery, so there is a lot of healing still to go, but her eyes are more open and much more symmetric already!

Will insurance pay for Asian Blepharoplasty?

Insurance companies have specific criteria for covering upper eyelid surgery. These criteria include specific eyelid measurements and documentation of vision blockage. A visual field test will be performed by Dr. Dewan to measure any blockage of vision. These findings are sent to your insurance company for approval following your consultation. If you meet their requirements, your insurance company will cover your operation. Typically, epicanthoplasty is not a covered procedure, and other cosmetic surgeries, such as lower eyelid blepharoplasty are not covered by insurance. Dr. Dewan is happy to provide a cost estimate for you regarding any surgery that may be cosmetic.

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